Center for Advanced Lung Disease and Transplantation

Immunosuppression and Organ Rejection

The purpose of your immune system is to protect your health. It recognizes and attacks anything different from the substances normally present in your body, even those only slightly different, like your newly transplanted lung. The immune system does not discriminate between harmful substances, like bacteria, fungi and viruses, and transplanted organs — so to your immune system your new lung appears as a foreign substance that needs to be eliminated.

To protect your new lung, we prescribe a variety of medications to suppress your body's natural immune response. These medications are called "immunosuppressants," and they trick the immune system into believing that your new organ is not foreign, and thus it is not attacked. After transplantation, you will be taking immunosuppressant medications for the rest of your life.

Understanding Organ Rejection

Even with the use of immunosuppressants, your body can at times recognize your transplanted organ as a foreign object and attempt to protect you by attacking it. Rejection is the term used when your body's immune system is attacking your transplanted organ. Nearly all patients will experience at least one episode of rejection. If and when you suffer an episode rejection, remember:

it does not mean that you will lose your new lung,

it does not mean your new lung is failing.

Rejection may occur early or late after transplantation. Early rejection occurs most often in the first six months after transplant, and late rejection typically occurs after six months.

Symptoms of Organ Rejection

The most common symptoms or signs of rejection are:

Flu-like symptoms

Cough/chest pain

Fatigue

Fever

Shortness of breath

Decreased peak flow

Decreased incentive spirometry

Decreased oxygen saturation

If you develop any of these symptoms or signs, contact your transplant team at once.

Monitoring for Rejection

Rejection can frequently be silent and without symptoms, and detected only by lung function testing. This is why we frequently measure your lung function during your hospitalization and at your follow-up clinic visits. In addition, a lung biopsy may be necessary to determine if rejection is actually occurring.

Pulmonary function tests, a measure of your lung function, will be performed weekly in the 3 months after your transplant, and less frequently thereafter. This test may reveal the first sign of rejection or infection. Your lung function will be followed at home with the measurement of spirometry and peak expiratory flow measurements, which you will record daily at home. Any persistent decrease in these values should be reported to the transplant team.

If rejection is suspected, a bronchoscopy, or lung biopsy, will be performed to rule out rejection or see if it is actually occurring.

Managing Organ Rejection

We manage a mild rejection episode by making adjustments to your medication dosages. Moderate or severe rejection may require a few days of hospitalization, allowing us to administer alternative immunosuppressants and observe your progress.